Optimizing Resilience In Orofacial Pain and Nociception

In recent years, there has been increasing interest in the contribution of positive
psychological factors (e.g., optimism, pain acceptance, hope) to pain and pain-related
coping. Although research supports the significance of these resilience factors in pain
adaptation, psychological interventions based upon bolstering resilience have received far
less attention. Emerging evidence supports the role of hope in psychosocial adjustment and
enhancement of adaptive pain coping skills. Hope is considered to be a positive motivational
state consisting of one's belief in their ability to generate routes to achieve goals
(pathways) and initiation towards attaining these goals (agency). In the context of pain,
increasing hope may promote augmentation of personal strengths to enhance development of
meaningful goal pursuits and foster resilient outcomes. Enhancement of hopeful thinking and
behavior may ultimately lead to the minimization of losses that are often associated with
chronic pain. This experience may be also reflected physiologically, as increasing hope may
confer biological benefits (e.g., decreased inflammation). Although hope-based interventions
have been successfully applied in other clinical conditions (i.e., cancer), their utility in
chronic pain disorders has not been examined.

To examine the effectiveness of this approach, a two-arm randomized trial will be conducted
with individuals who have TMD. In Study Arm 1, participants will receive hope-based therapy.
In Study Arm 2, participants will receive pain education. Participants will attend 5
sessions over a period of 5 weeks. Two of these sessions will involve quantitative sensory
pain testing; three sessions will include delivery of the treatment intervention. Pain
outcomes will be measured at pre- and post-treatment.

Aims:

1. Examine the degree to which state and trait levels of hope are predictive of clinical
pain, disability, affective distress, and experimental pain.

2. Investigate the effects of a hope intervention, as compared to an education control
group, on clinical and experimental pain in individuals with TMD.

3. Identify psychosocial (e.g., hope, optimism, positive affect, catastrophizing),
biological (e.g., inflammatory, endogenous opioid, neuroendocrine), and psychophysical
factors associated with positive treatment response (i.e., reduction of clinical pain).

Inclusion Criteria:

- participants between the ages of 18 and 65

- meets Research Diagnostic Criteria for TMD

- duration of pain is at least 3 months

- pain at least 15 days in the past month

- pain rated moderate to severe in intensity

Exclusion Criteria:

- uncontrolled hypertension

- current heart disease including heart failure

- kidney failure or currently undergoing dialysis

- current neurological conditions that could affect protocol safety or validity

- facial trauma or orofacial surgery within the last 6 months

- currently in orthodontic treatment

- currently pregnant and/or nursing

- use of narcotic analgesics (i.e., opioids) on a daily basis

- a primary pain condition other than TMD